Penn Researchers Find That Chronic
Dizziness May Be Caused
By Psychiatric and Neurologic IllnessesResults show that patients’ symptoms are not a mystery,
allowing
physicians to better diagnose and treat the cause

Among the various forms of dizziness, clinicians have found CSD to be
particularly vexing. “Patients with CSD experience persistent
dizziness not related to vertigo,
imbalance, and hypersensitivity to motion, which is heightened in highly
visual settings, such as walking in a busy store or driving in the rain,” says Jeffrey
P. Staab, MD, MS, Assistant Professor, Departments of Psychiatry and Otorhinolaryngology at
Penn, and coauthor of the paper.

Staab and coauthor, Michael
J. Ruckenstein, MD, Associate Professor, Department
of Otorhinolaryngology at Penn, studied 345 men and women age
15 to 89 (average age 43.5) who had dizziness for three months or
longer due to unknown causes. From 1998 to 2004, the patients
were tracked from their referral to Penn’s
Balance Center through multiple specialty examinations until
they were given a diagnosis.

“All but six patients were diagnosed as having psychiatric or neurologic conditions,
including primary or secondary anxiety disorders, migraine, traumatic
brain injury and neurally mediated dysautonomias,” said Ruckenstein. Most
patients (59.7%) had CSD with anxiety, 38.6% had CSD and illnesses of
the central nervous system (migraine, traumatic brain injuries, or dysautonomias),
and 1.7% had CSD and irregular
heartbeats.

Two-thirds of patients had medical conditions associated with the onset
of dizziness, whereas one-third had anxiety disorders as the initial
cause. Therefore, CSD may be triggered by either neurologic or
psychiatric conditions.

Key diagnostic features were identified in the clinical history for
each illness. For example, those with migraines often had nausea
or vomiting, anxiety disorders were associated with fear and worry, and
those with dysautonomias tended to become dizzy when they exerted themselves. “Careful
inquiry about these key features during exams may lead to better diagnoses
and more specific treatment recommendations for the many patients with
chronic dizziness who have not found a cause for their symptoms and those
who have been given diagnoses that have not brought them relief,” says
Staab.

This study was not supported by commercial funding.

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